PRECANCEROUS LESIONS OF THE CERVIX UTERI

Abstract

This article deals with the problem of dysplasia of the cervix which is a pathology common in 40-year old women. Its prevalence varies between 29 and 65 out of 1000; therefore its detection essentially depends on cervical cytology and on colposcopy. Dysplasia starts in the area of junction between the squamous epithelium and the cylindrical epithelium; the virus infects the malpighian epithelial cells that multiply in cervical lesions. However some rare instances of dysplasia can occur outside the area of junction on the periphery of the cervix or on the vagina. Dysplasias may heal or stabilize but an aggravation toward a more severe case of dysplasia or even a cancer in situ constitute the major risk. According to the World Health Organization dysplasia can be mild moderate or severe. Diagnosis is made in 3 examinations: cervico-vaginal cytology which can detect a high or low-grade case of dysplasia; the technique must be rigorous and must be done during the pre-ovulation phase. Then there is the smear test which must include endo-cervical cells and those of the squamo-cylindrical junction and it should present neither an inflammatory appearance nor a cellular lysis. Finally there is the colposcopy which should be done in any patient who presents any anomalies from the cervico-vaginal smear test; this technique makes it possible to differentiate the grade I and grade II atypical transformation areas. The treatment must be done using various methods depending on the degree of dysplasia. In the case of a mild CIN1 dysplasia and if the lesions do not disappear at the end of 6 to 9 months it is preferable to destroy it using the CO2 laser by cryrotherapy or by electro-coagulation. In the case of moderate CIN1 dysplasia destructive treatment with the CO2 laser is indicated if the lesions are not very extensive; but in the case of involvement of the glands the use of a deep resection with a diathermal loop is indicated where a hemi-conization is essential. Finally in the event of several dysplasia it is recommended that a conization be done; however during a pregnancy a complete colposcopic and histological evaluation must be done while a conization must be ruled out in order to avoid a miscarriage. The monitoring must be strict and regular in order to do smears colposcopies and eventually biopsies. Sequential estro-progestational agents must be avoided opting for those that are combined in mini-doses.